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  • Update: State Decisions on the Health Insurance Policy Cancellations Fix - The Commonwealth Fund
    D C have publicly announced that they will not implement the transitional policy fix Although some of these states allowed insurers to reinstate canceled policies until December 31 2013 insurers in these states are not permitted to renew policies that do not comply with the Affordable Care Act after January 1 2014 Of these the states running their own state based health insurance marketplace were among the quickest to reach a decision For the past three years these states have overcome numerous challenges to build and launch a marketplace and have made critical policy decisions to ensure that their exchanges will thrive In California Minnesota and Washington for example state officials declined to adopt the transitional policy fix citing concerns that included administrative obstacles consumer confusion and a potential increase in premiums in 2015 Not all states are rejecting the president s proposal particularly those where the federal government is operating the exchange To date Alabama Florida Georgia Kansas Illinois Iowa Louisiana Maine Michigan Missouri Montana New Hampshire New Jersey North Carolina North Dakota Ohio Pennsylvania 1 South Carolina South Dakota Tennessee Texas Utah Wisconsin and Wyoming are allowing people with canceled policies to renew in 2014 Hawaii Idaho Kentucky and New Mexico all operating their own marketplaces also adopted the fix These states had already allowed the early renewal of policies which is consistent with the president s fix Effect of state law on decisions Along with concerns about the success of the marketplaces a key consideration for state officials is whether they have the legal authority to allow or prohibit the transitional policy fix As noted in a previous post some states had already taken regulatory action or interpreted existing law to allow or prohibit early renewals or the renewal of coverage that doesn t meet the Affordable Care Act s standards prior to December 31 2013 Many states also passed their own laws applying some or all of the Affordable Care Act s market reforms to coverage issued or renewed in their state on or after January 1 2014 These market reforms include the coverage of a minimum set of essential health benefits and the ban on preexisting condition exclusions The existence of such laws may mean that regulators are unable to allow renewals in 2014 Although federal regulators will not enforce the market reforms for plans in the individual market that are renewed in 2014 state regulators may not have the same flexibility Maryland for example noted that renewals will not be permitted after January 1 2014 because plans would not comply with federal and state laws State officials in California and Nevada suggested the same In states that adopt the transitional policy fix but passed new legislation on one or more of the market reforms such as Maine it is unclear how regulators will apply rules that no longer exist The lack of formal rules could lead to questions about which standards apply to renewal coverage and at worst a regulatory vacuum As we have

    Original URL path: http://authoring.commonwealthfund.org/publications/blog/2013/nov/state-decisions-on-policy-cancellations-fix (2016-04-30)
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  • What States Are Doing to Simplify Health Plan Choice in the Insurance Marketplaces - The Commonwealth Fund
    Overview The new health insurance marketplaces aim to improve consumers purchasing experiences by setting uniform coverage levels for health plans and giving them tools to explore their options Marketplace administrators may choose to limit the number and type of plans offered to further simplify consumer decision making This issue brief examines the policies set by some state based marketplaces to simplify plan choices adopting a meaningful difference standard limiting the number of plans or benefit designs insurers may offer or requiring standardized benefit designs Eleven states and the District of Columbia took one or more of these actions for 2014 though their policies vary in terms of their prescriptiveness Tracking the effects of these different approaches will enhance understanding of how best to enable consumers to make optimal health insurance purchasing decisions and set the stage for future refinements e Alerts and Newsletter Sign up Downloads Issue Brief Publication Details Publication Date December 18 2013 Authors Christine Monahan Sarah J Dash Kevin Lucia Sabrina Corlette Summary Writer Martha Hostetter Citation C H Monahan S J Dash K W Lucia et al What States Are Doing to Simplify Health Plan Choice in the Insurance Marketplaces The Commonwealth Fund December 2013 Related

    Original URL path: http://authoring.commonwealthfund.org/publications/issue-briefs/2013/dec/simplify-health-plan-choice (2016-04-30)
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  • Marketplace IT Glitches: The Sky Is Not Falling - The Commonwealth Fund
    are paid correctly Getting these systems right under very tight deadlines is an enormous task Like all new start ups the marketplaces are sure to experience glitches especially right after launch Similar concerns arose during the rollout of the Medicare Part D prescription drug benefit program in 2005 For example transitioning low income Medicare beneficiaries from Medicaid drug coverage to Part D involved data exchanges among states the Centers for Medicare and Medicaid Services and private drug plans Before Part D launched many observers worried that the data transfers would not work as required And in fact at first they didn t Some beneficiaries learned at the pharmacy counter that their subsidy was not recognized by the pharmacist s IT system or that their prescribed drug was not covered by their plan In response federal and state officials and insurer representatives cooperated to provide workarounds and temporary patches while the systems were improved Today the Medicare Part D program has become a core part of Medicare and a popular benefit among seniors delivering lifesaving drugs to millions of beneficiaries Similar administrative and IT related glitches will undoubtedly affect the marketplaces To allow for the smoothest possible rollout some states and the federal government have announced they will phase in certain features of their marketplaces For example in Vermont consumers will be able shop compare and select a plan starting October 1 but will have to wait until November to pay electronically for their policies Small businesses in states with federally managed SHOP Small Business Health Options Program exchanges will also have to wait until later in the fall to enroll online although they will be able to compare plans and send in a paper application starting October 1 In Oregon consumers will initially be referred through Cover Oregon s website to an insurance agent or enrollment assister known in the state as a community partner to enroll in a policy rather than being able to sign up directly In the District of Columbia which is refining its system for automatic eligibility determinations trained experts will work one on one with people who may be eligible for Medicaid and make an eligibility determination so that people can be enrolled as quickly as possible People eligible for premium subsidies will be able to create an account on DCHealthLink and review plan options and will receive their eligibility determination in early November For the federal government and each of these states there is infrastructure in place to identify bugs and resolve them as quickly as possible And more importantly there has been no suggestion of any delay in the actual date coverage will begin January 1 2014 For consumers who have long been shut out of the insurance system because of a preexisting health condition or an inability to afford insurance that covers their medical needs or for those who have previously experienced long waits and administrative barriers to enrolling in Medicaid the marketplaces open the door to a new era of consumer

    Original URL path: http://authoring.commonwealthfund.org/publications/blog/2013/sep/it-marketplace-glitches (2016-04-30)
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  • The Affordable Care Act's Early Renewal Loophole: What's at Stake and What States Are Doing to Close It - The Commonwealth Fund
    their rates which have been coming in lower than anticipated in a number of states insurers will need to make up for the higher risk the following year That means higher premiums for everyone in 2015 Early renewals are also likely to breed even more confusion than already exists about what the Affordable Care Act does and when its rules go into effect Consumers may not understand all the new benefits they may give up if they renew early Indeed some insurers are asking policyholders to decide to renew before state health insurance marketplaces go live meaning consumers won t have an opportunity to compare their current plan with the new marketplace options State Action While the Obama Administration has not published any guidance on early renewals some states are stepping up to prohibit or limit the practice Three states have prohibited early renewals in both individual and small group markets In explaining its ban Missouri referred to language in the state insurance code specifying that renewals cannot occur more than once a year while Illinois and Rhode Island informed insurers that they would withhold approval from forms for early renewal products Illinois reasoned that early renewing violate s the spirit and intent of the law that the market reforms be administered in a consistent and timely manner and Rhode Island officials cited concerns about discrimination and questioned the financial soundness of extending current rates for early renewal products without adjusting for additional costs such as medical inflation and new taxes and fees Three other states have banned early renewals in only certain markets New York passed new legislation prohibiting early renewals in the small group market Washington outlawed early renewals by association health plans while soliciting public comment on action in its traditional individual and small group markets California has made terminating all non ACA compliant individual policies by December 31 2013 a condition for insurer participation in its individual exchange Massachusetts and Oregon took a different approach requiring individual market policies issued in 2013 to end no later than March 31 2014 While not prohibiting early renewals explicitly this approach makes taking advantage of the loophole less attractive because insurers plans will have to come into compliance with the ACA market reforms by April 1 2014 Other states issued guidance permitting early renewals but set rules for the practice and in some cases explicitly cautioned insurers about how they should proceed Idaho and Kentucky for example expressed concern that early renewals may be discriminatory and required insurers offering early renewals to make the option available to all current policyholders Montana set similar rules to prevent discrimination and prohibited insurers from charging higher premiums for early renewal policies that offer substantially similar benefits and cost sharing as the pre renewal policy Other states including Arkansas and Colorado established notification requirements to help ensure that consumers understand all of their options and insurers are not using early renewals to risk select However these rules may not be enough to prevent

    Original URL path: http://authoring.commonwealthfund.org/publications/blog/2013/aug/the-affordable-care-acts-early-renewal-loophole (2016-04-30)
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  • Implementing the Affordable Care Act: Choosing an Essential Health Benefits Benchmark Plan - The Commonwealth Fund
    Print Overview To improve the adequacy of private health insurance the Affordable Care Act requires insurers to cover a minimum set of medical benefits known as essential health benefits In implementing this requirement states were asked to select a benchmark plan to serve as a reference point This issue brief examines state action to select an essential health benefits benchmark plan and finds that 24 states and the District of Columbia selected a plan All but five states will have a small group plan as their benchmark Each state whether or not it made a benchmark selection will have a set of essential health benefits that reflects local employer based health insurance coverage currently sold in the state States adopted a variety of approaches to selecting a benchmark including intergovernmental collaboration stakeholder engagement and research on benchmark options e Alerts and Newsletter Sign up Downloads Issue Brief Publication Details Publication Date March 12 2013 Authors Sabrina Corlette Kevin Lucia Max Levin J D M A Summary Writer Deborah Lorber Citation S Corlette K W Lucia M Levin Implementing the Affordable Care Act Choosing an Essential Health Benefits Benchmark Plan The Commonwealth Fund March 2013 Related Publications April 13 2016 Obama

    Original URL path: http://authoring.commonwealthfund.org/publications/issue-briefs/2013/mar/choosing-an-essential-health-benefits-benchmark-plan (2016-04-30)
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  • Implementing the Affordable Care Act: State Action on the 2014 Market Reforms - The Commonwealth Fund
    Act includes numerous consumer protections designed to improve the accessibility adequacy and affordability of private health insurance Because states are the primary regulators of health insurance this issue brief examines new state action on a subset of protections such as guaranteed access to coverage and a ban on preexisting condition exclusions that go into effect in 2014 The analysis finds that to date only one state passed new legislation on all of these protections and an additional 10 states and the District of Columbia passed new legislation or issued a new regulation on at least one protection The analysis also finds that without new legislation some states face limitations in fully enforcing these reforms These findings suggest an acute need for states to take action in 2013 to help ensure that consumers are fully protected by and benefit from the Affordable Care Act s most significant reforms e Alerts and Newsletter Sign up Downloads Issue Brief Publication Details Publication Date February 1 2013 Authors Katie Keith Kevin Lucia Sabrina Corlette Citation K Keith K W Lucia and S Corlette Implementing the Affordable Care Act State Action on the 2014 Market Reforms The Commonwealth Fund February 2013 Related Publications April 13

    Original URL path: http://authoring.commonwealthfund.org/publications/issue-briefs/2013/feb/state-action-2014-market-reforms (2016-04-30)
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  • Child-Only Coverage and the Affordable Care Act: Lessons for Policymakers - The Commonwealth Fund
    denying or limiting coverage for children under the age of 19 in 2010 In response some insurers ceased to offer coverage to children in need of individual health insurance known as a child only policy This issue brief examines new state legislative and regulatory action to promote the availability of child only policies in response to this market disruption The analysis finds that 22 states and the District of Columbia passed new legislation or issued a new regulation or subregulatory guidance As a result child only coverage is available in nearly all of these states These findings suggest that states have flexibility to take innovative actions to maintain or improve their markets and insurers are highly sensitive to the risk of adverse selection The findings also suggest the need for meaningful regulatory incentives to avoid market disruption in successfully implementing broader reforms in 2014 e Alerts and Newsletter Sign up Downloads Issue Brief Publication Details Publication Date October 9 2012 Authors Katie Keith Kevin Lucia Sabrina Corlette Citation K Keith K W Lucia and S Corlette Child Only Coverage and the Affordable Care Act Lessons for Policymakers The Commonwealth Fund October 2012 Related Publications April 13 2016 Obama Administration Moves

    Original URL path: http://authoring.commonwealthfund.org/publications/issue-briefs/2012/oct/child-only-coverage-and-the-affordable-care-act (2016-04-30)
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  • Implementing the Affordable Care Act: State Action on Early Market Reforms - The Commonwealth Fund
    Commonwealth Fund March 2012 Add to My Library Print The Affordable Care Act includes numerous consumer protections that took effect on September 23 2010 This issue brief examines new state action on a subset of these early market reforms The analysis finds that 49 states and the District of Columbia have passed new legislation issued a new regulation issued new subregulatory guidance or are actively reviewing insurer policy forms for compliance with these protections These findings suggest that states have required or encouraged compliance with the early market reforms and that efforts to understand how states are responding cannot focus on legislative action alone The findings also raise important questions regarding how states may implement the Affordable Care Act s broader 2014 market reforms and suggest the need for continued tracking of state action e Alerts and Newsletter Sign up Downloads Issue Brief Publication Details Publication Date March 22 2012 Authors Katie Keith Kevin Lucia Sabrina Corlette Citation K Keith K W Lucia and S Corlette Implementing the Affordable Care Act State Action on Early Market Reforms The Commonwealth Fund March 2012 Related Publications April 13 2016 Obama Administration Moves Forward with New Continuity of Care Protections How Will They

    Original URL path: http://authoring.commonwealthfund.org/publications/issue-briefs/2012/mar/state-action (2016-04-30)
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